710384.pdfI
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
Q
W MAILING ADDRESS
3 103 l >9
JIM6
ME
m
0
i-
u
a
0:
F
Z
0
u
J. N'rNy
LOT
USE
PERMIT
Applicant Fill
ZONEK
NUMBER
-
Inside Heavy Lines
/oB
' IT -I•
ADDRESS
7 jf
"CI
LLOT'
A
G
AREA
SUBOW15
or
tV ,
HONE NUMBER
40 eo
,HONC NUMBER
NO.
LE AL
❑ YES ❑ NO
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT,
0
REMARKS Z
K
W
EREOUIRED:,:::
BY W
113
Z
STREET AND/OR UTILITY WORK ERIWPERMWREQ'D. ❑ YES NO❑
UNDERGROUND
WIRING REQ'D. ❑ YES Cl NO
TYPE CONNECTION ❑YES VERIFIED BY
SANITARY SEWER ❑ NO
SEPTIC SYSTEM ❑ YES PERMIT NUMBER
APPV'D BY CITY ENG. ONO
R
-I O / l D 1 //(+�'^'�D SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
m
U
0
W
D
J
REMARKS '
a
•
III
J
VARIANCE PLANNING REVIEW BY DATE
CE OR CU
Z
O
I=
6
m
U
H
W
G
FRONT
SIDE REAR
a NEW
RESIDENTIAL
GAS
LINE
FIRE ZONE TYPE OF CONSTRUCTION CODE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
NIA I.L NINO
SPECIAL REQUIRED
AREA OCCUPANCY OCCUI
GROUP LOAD
GROUP
❑ ❑ NO
❑ ALTER
❑
EXCAVATE
OR FILL
❑
FENCE
( X�FT)
YES
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE Cll
SALES TF
OF EDMONDS. LOCAL
❑ REPAIR
PRE -MOVE
❑SWIM
POOL
SHOULD BE CODED 31,04,
INSP,
REMARKS
(UMBER OF STORIES
F
DWELLING
UNITS
IATURE OF WORK TO BE DONE
ING
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed In 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject t"lan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
VALUATION
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
AL AMOUNT DUE
FEE
A f O
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit
AUTHORIZES until signed by the Building Official or
ONLY THE his Deputy; and fees are paid, and
WORK NOTED receipt is acknowledged in space pro-
ded.
INSPECTION
DEPARTMENT R T 'S ATUR
CITY OF
EDMONDS DA
775-2525-
ORIGINAL - File YELL -Inspector
GOLD - Assessor PI K - Owner
F
Z
W
f
F
C
Q
6
W
0
F
Z
W
F
n
0
J
W
W
W
0
}
F
Z
7
is
i
O
U